Angulated Group Research Articles

Effects of Ultrasonic Instrumentation on the Shear Bond Strength of Ceramic Brackets: An In Vitro Study

Aim: Accumulation of plaque during orthodontic treatment makes oral prophylaxis a regular necessity. The use of esthetic brackets has gained popularity, it becomes necessary to assess the consequences of ultrasonic instrumentation during oral prophylaxis on ceramic bracket’s shear bond strength (SBS). Materials and Methods: Fifty-four premolar teeth which were extracted due to therapeutic reasons were divided into six groups with each group containing nine teeth each. Ceramic brackets were bonded onto the labial surfaces using two different adhesive systems (Ormco Enlight and Transbond) and were subjected to ultrasonic scaling at different scaler tip angulations. The samples were then rendered a debonding force in a Universal testing machine and the bond strengths were assessed. Results: In terms of angulation of ultrasonic instrumentation, among the groups bonded with the Ormco Enlight, the 45° angulation group had statistically significant higher bond strength values compared to the 0° angulation group. Among the transbond groups, there was no statistically significant difference in the bond strengths even though the 45° angulation group had slightly higher bond strength value than the 0° angulation group. Conclusion: Supragingival scaling around the bracket base at 0° around the ceramic brackets for 1 min resulted in the reduction of SBS. Therefore, the clinicians should be cautious during plaque removal, avoid performing extended ultrasonic instrumentation at the bracket base, especially at 0° angulation.

Influence of implant angulation and clinical implant scan body height on the accuracy of complete arch intraoral digital scans

Statement of problemThe accuracy of digital implant scans can be affected by the implant angulation, implant depth, or interimplant distance. However, studies analyzing intraoral scanning accuracy with different implant angulations and different scan body heights are scarce. PurposeThe purpose of this in vitro study was to determine the influence of the implant angulation and clinical implant scan body height on the accuracy of complete arch scans. Material and methodsTwo definitive implant casts with 6 implant analogs (Zimmer Biomet) were obtained: 1 cast had all the implant analogs parallel (GP group), and 1 cast had the implant analogs with divergence of up to 30 degrees (GD group). A coordinate measurement machine (Global Evo 09.15.08) was used to measure the positions of the implant analogs. Each group was divided into 3 subgroups depending on the clinical implant scan body height: 10, 6, and 3 mm. An implant scan body (Elos Accurate Scan Body Brånemark system) was positioned on each implant analog. A total of 10 scans of each subgroup were recorded by using an intraoral scanner (TRIOS 3). Each STL file obtained was imported into a reverse engineering software program (Geomagic), and linear and angular Euclidean measurements were obtained. The Euclidean calculations between the implant analog positions of the definitive implant casts were used as a reference to calculate the discrepancies among the corresponding subgroups. The Kolmogorov-Smirnov test revealed that the lineal measurements were not normally distributed, so the Kruskal-Wallis and pairwise comparison Dunn tests were used (α=.05). The Kolmogorov-Smirnov test revealed that the angular measurements were normally distributed. Therefore, the 2-way ANOVA and pairwise comparison Tukey tests were used (α=.05). ResultsThe Kruskal-Wallis test revealed significant differences in the linear Euclidean medians between the GP and GD groups with different clinical implant scan body heights (H(5)=23.18, P<.001). Significant differences in the linear Euclidean medians were computed between the GP-6 and GD-10 subgroups (P=.009), GD-3 and GD-6 subgroups (P=.029), and GD-3 and GD-10 subgroups (P=.001). Two-way ANOVA revealed that the implant angulation (F(1, 3.3437)=28.93, P<.001) and clinical implant scan body height (F(2, 0.4358)=3.77, P=.029) were significant predictors of discrepancies in the angular measurement. ConclusionsImplant angulation and clinical scan body height influenced scanning accuracy. The lowest clinical implant scan body height tested had the lowest accuracy in both parallel and angled implants, but statistically significant differences were found only in the angled group.

Efficacy of stylet angulation at the holding position during tracheal intubation with a videolaryngoscope: a randomized controlled trial

The aim of this randomized controlled trial was to determine the efficacy of stylet angulation at the holding position during tracheal intubation with a McGRATH MAC videolaryngoscope. Patients were randomized to a group for intubation without stylet angulation at the holding position (non-angulation group) and to a group for intubation with stylet angulation at the holding position (angulation group). The primary outcome was the time for placement of the tracheal tube. Sixty patients were analyzed. The mean (standard deviation) times for tube placement were 21.3 (5.6) s in the non-angulation group and 16.9 (3.8) s in the angulation group (P < 0.001). The scores of operator's perception of difficulty in tube delivery, number of attempts for tube delivery, and degrees of extension, abduction, internal rotation of the right upper arm and extension of the right wrist during tube placement in the angulation group were significantly smaller than those in the non-angulation group (P < 0.001, P = 0.002, P < 0.001, P < 0.001, P < 0.001, P < 0.001, respectively). Our results suggest that stylet angulation at the holding position improves maneuverability of the tracheal tube and enables easy, smooth, and swift tube placement during tracheal intubation with a McGRATH MAC videolaryngoscope.

The retention difference between cobalt chromium and zirconia coping in different angulations on telescopic overdenture

Telescopic overdenture is one type of removable denture that uses dual coping system that consists of primary and secondary coping. Retention of telescopic overdenture is obtained from the friction between primary and secondary coping, which is mainly influenced by the type of material and coping angulation. The purpose of this study is to determine the retention differences between CoCr and zirconia coping with 0°, 1°, and 2° angulations. Twenty four pairs of telescopic overdenture coping samples with 6 mm length were divided into 6 groups (n = 4), CoCr 0°, CoCr 1°, CoCr 2°, zirconia 0°, zirconia 1°, and zirconia 2°. Measurement of retention between coping is done by pull-off test using universal testing machine (UTM) and data were analyzed by two way ANOVA. The results showed that the largest average retention was found in zirconia coping with 0° angulation group (22.48 N), while the smallest average retention was found in CoCr coping with 2° angulation group (10.28 N). Two way ANOVA revealed that there were significant differences among groups (p&lt;0.05). LSD tests showed that there were significant differences among all of groups. This study concludes that zirconia coping has higher retention than CoCr coping and coping with 0° angulation has the highest retention.

Radiographic differences in the concomitant deformities in two types of medial ankle osteoarthritis.

ObjectivesMotion preserving surgeries could be unsuccessful because of underestimation of deformities of the foot and knee in ankle osteoarthritis. This study aimed to investigate the concomitant deformities in medial ankle osteoarthritis and the difference between the two types, varus angulation and medial translation.MethodsA retrospective study was conducted using medical records and radiographic data. Patients with medial ankle osteoarthritis that underwent weight-bearing X ray imaging and radiographic measurements including tibial plafond inclination (TPI), tibiotalar tilt angle (TT), lateral talo-first metatarsal angle, naviculo-cuboid overlap, and mechanical tibiofemoral angle (mTFA) were studied. The patients were categorized into two groups, the varus angulation group (TT ≥4°) and medial translation group (TT <4°). The radiographic measurements were compared between the two groups.ResultsA total of 102 patients (male = 44; female = 58) were included; the mean age was 64.9 years (SD 8.3 years). The varus rotation group (N = 66) showed a significantly smaller lateral talo-first metatarsal angle (p<0.001), naviculo-cuboid overlap (p<0.001), and mTFA (p = 0.019) compared to the medial displacement group (N = 36). The TT showed a significant correlation with lateral talo-first metatarsal angle (r = -0.520, p<0.001), naviculo-cuboid overlap (r = -0.501, p<0.001), and mTFA (r = -0.243, p = 0.014). Lateral talo-first metatarsal angle was found to be the significant factor (p = 0.018) discriminating varus angulation and medial translation types in the binary logistic analysis.ConclusionsVarus angulation of the ankle was correlated with knee alignment and foot deformity. Radiographic indices were different between the varus angulation and medial translation groups. The role of concomitant deformities needs to be further investigated in terms of a causal relationship. Surgeons need to pay attention to concomitant deformities in the treatment of medial ankle osteoarthritis.

Preoperative Neck Angulation is Associated with Aneurysm Sac Growth Due to Persistent Type Ia Endoleak after Endovascular Abdominal Aortic Aneurysm Repair.

Objective: This study aims to determine how instructions for use affect the occurrence of aneurysm sac growth and endoleaks after an endovascular aneurysm repair (EVAR).Materials and Methods: We reviewed 302 patients who underwent EVAR for abdominal aortic aneurysm between 2007 and 2013, and we were able to enroll 159 patients (74% men, mean age 78±7 years) with adequate data (mean follow-up; 48±20 months).Results: The angle of the proximal landing zone (LZ) (hazard ratio: 1.02, 95% confidence interval: 1.00–1.03, p=0.01) was recognized as an independent risk factor of sac growth (≥5 mm). The receiver operating characteristics curve (area under the curve: 0.72) showed a cutoff value of 47° of the minimum angle of the proximal LZ to predict sac growth. Freedom rates for persistent type Ia endoleaks were also found to be lower in the angulated group than those in the other groups (p=0.0095, log-rank).Conclusion: The angle of the proximal LZ was identified as an independent risk factor for sac growth post-EVAR. The incidence of persistent type Ia endoleaks was significantly higher in the angulated group.

Impact of suprarenal neck angulation on endovascular aneurysm repair outcomes

BackgroundHostile infrarenal proximal neck (β) anatomy of abdominal aortic aneurysm has been associated with increased risk of aneurysm-related complications after endovascular aneurysm repair (EVAR). However, there is a paucity of literature addressing the suprarenal angle (α). The aim of this study was to evaluate short- and long-term outcomes after EVAR in patients with severe suprarenal neck angulation (α >60 degrees). MethodsA retrospective review of the medical records of 561 patients who underwent EVAR between January 2005 and December 2017 was performed. The main exclusion criteria were preoperative aneurysm rupture and fenestrated or branched endograft placement. High-resolution computed tomography images of 452 patients were available. Patients were grouped into angulated (α >60 degrees) and nonangulated (α ≤60 degrees) groups. The primary end point was freedom from type IA endoleak. Secondary end points included 30-day mortality, long-term survival, primary clinical success, and freedom from aneurysm rupture and graft migration. Primary clinical success was defined according to Society for Vascular Surgery guidelines as clinical success without the need for an additional or secondary surgical or endovascular procedure. ResultsOf 452 patients, 45 (10%) were included in the angulated group (α >60 degrees). Median follow-up time was 34 months (interquartile range, 14-56 months). Compared with patients in the nonangulated group, those in the angulated group had larger neck diameter at the level of the renal arteries (mean [standard deviation], 25.6 [3.8] mm vs 24.6 [3.4] mm; P = .06) and increased β angle (mean [standard deviation], 50.5 [22.9] degrees vs 41.6 [23.9] degrees; P = .01). The 3-year freedom from type IA endoleak estimate was 80.2% for the angulated group compared with 97.8% for the nonangulated group (P < .001). The angulated group showed significantly higher 30-day mortality (11.1% vs 0.25%; P < .001).The 3-year results showed that patients in the nonangulated group had higher rates of primary clinical success (90.2% vs 67.1%; P < .001), freedom from rupture (99% vs 97.1%; P = .02), freedom from migration (100% vs 92.4%; P < .001), and long-term survival (91.6% vs 75.8%; P = .006) compared with those in the angulated group. After adjustment for age, sex, neck diameter, and β angle, severe suprarenal neck angulation was associated with higher odds of type IA endoleak (adjusted hazard ratio, 8.9; 95% confidence interval [CI], 2.9-27), loss of primary clinical success (adjusted hazard ratio, 4.8; 95% CI, 2.6-8.9), and 30-day mortality (adjusted odds ratio, 52.5; 95% CI, 5.3-514) compared with α ≤60 degrees (all P < .001). ConclusionsThis is the first report to show a significant increase in operative mortality in patients undergoing EVAR with severely angulated suprarenal neck. Patients who survive the operation are at increased risk of secondary interventions. These findings suggest that EVAR should be used with caution in patients with severe α angulation and underpin the role of close follow-up in this particular population.

Effect of Screw Channel Angulation on Reverse Torque Values of Dental Implant Abutment Screws.

To compare the reverse torque values (RTVs) of abutment screws tightened from three different angles. Implant abutment screws (n = 48), abutments (3), and regular platform implant analogs (3) were divided into three angulation groups (n = 16/group). Custom guides of 0°, 10°, and 20° were fabricated to verify driver angulation. The implant components for each group were assembled and all screws torqued to 35 Ncm using a universal screwdriver in a manual torque wrench at the appropriate angle. Torque was reapplied 10 minutes after initial torque. A digital gauge was then used to measure reverse torque at a position parallel (0°) to the implant analog. RTVs were recorded and compared using one-way ANOVA and Tukey HSD post-hoc comparisons (α = 0.05). All mean RTVs fell below the targeted torque value of 35Ncm, with some values in each angulation group 10% below of the target value. Mean RTVs in descending order from targeted torque value were: 10° group = 32.07 ± 0.97 Ncm, 0° group = 31.16 ± 1.12 Ncm, and 20° group = 30.08 ± 0.88 Ncm. One-way ANOVA revealed significant differences between angulation groups (F = 15.954, p < 0.001). Tukey HSD post hoc comparisons revealed that the mean RTVs of the three angulation groups were significantly different from each other (0° vs. 10°: p = 0.033; 0° vs. 20°: p = 0.011; 10° vs. 20°: p < 0.001). All RTVs did not reach the targeted torque value of 35 Ncm. Mean screw RTVs were significantly influenced by screwdriver insertion angulation.

Accuracy of different definitive impression techniques with the all-on-4 protocol

Statement of problemA nonpassive fit of implant-supported restorations can jeopardize the biological and mechanical success of the treatment. Data regarding the fit of different impression techniques for the all-on-4 protocol are limited. PurposeThe purpose of this in vitro study was to digitally evaluate 4 different impression techniques used with the all-on-4 protocol, with distal multiunit analogs positioned in 4 different angulations. Material and methodsFour maxillary definitive cast models with 4 multiunit analogs (T0 32202; NucleOSS) were fabricated according to the all-on-4 treatment protocol. In the anterior region, the analogs were positioned in a parallel direction, whereas in the posterior region, they were positioned in different angulations (0, 10, 20, and 30 degrees). One hundred and sixty models were obtained by using 4 different impression techniques (closed tray without plastic cap, closed tray with plastic cap, splinted open tray, sectioned resplinted open tray) (n=10) and polyvinyl siloxane impression material. Definitive casts and definitive duplicate casts were scanned using a modified laser scanner (Activity 880; Smart Optics Sensortechnik GmbH), and data were transferred to a software program (VRMesh Studio; Virtual Grid Inc). The definitive casts and definitive duplicate cast scans were digitally aligned. Angular and linear deviations in all axes (x, y, and z) of the analogs between definitive and duplicate casts were calculated and subjected to statistical analyses (α=.05). ResultsMean angular deviations were in the range of 0.03 to 0.16 degrees, and linear deviations were in the range of 0.10 to 0.75 mm. The increased angulation between impression copings caused higher linear and angular deviations when closed-tray impression techniques were used (P<.05). ConclusionsReduced linear and angular displacements were obtained from the open-tray impression techniques compared with the closed-tray impression techniques in the angulated groups. Angular and linear deviations increased with the increase in the angulation of the posterior analog.

Impact of Suprarenal Neck Angulation on Endovascular Repair Outcomes

Hostile infrarenal proximal neck (β) anatomy of abdominal aortic aneurysm (AAA) has been associated with increased risk of aneurysm-related complications after endovascular repair (EVAR). However, there is a paucity of literature addressing the suprarenal angle (α). The aim of this study is to evaluate short and long-term outcomes after EVAR in patients with severe suprarenal neck angulation (>60°). A retrospective review of the medical records of 501 patients who underwent EVAR between January 2005 and December 2017 was performed. High-resolution computed tomography images of 462 patients (92.2%) were available. Patients were grouped into angulated (α > 60°) and nonangulated (α ≤ 60°) groups. The primary end point was freedom from type IA endoleak. Secondary end points included 30-day mortality, long-term survival, primary clinical success and freedom from aneurysm rupture and graft migration. Primary clinical success was defined in according to Society for Vascular Surgery guidelines as clinical success without the need for an additional or secondary surgical or endovascular procedure. Of 462 patients, 47 (10.17%) were included in the angulated group (α > 60°). The median follow-up time was 33 months (interquartile range, 14-55). Compared with patients in the nonangulated group, those in the angulated group had larger neck diameter at the level of the renal arteries (mean, 25.8 ± 3.8 mm vs 24.6 ± 3.4 mm; P = .029) and increased infrarenal angle (β; mean, 50.1 ± 22.6° vs 41.7 ± 23.9°; P = .02). The 3-year freedom from type IA endoleak estimates were 80.9% for the angulated group compared with 97.9% for the nonangulated group (P < .001; Fig). The angulated group showed significantly higher 30-day mortality (12.8% vs 0.5%; P < .001). In contrast, the 3-year results showed that patients in the nonangulated group had higher rates of primary clinical success (89% vs 68.1%; P < .001), freedom from rupture (99% vs 97.2%; P = .02), freedom from migration (100% vs 92.6%; P < .001), and long-term survival (91.4% vs 75.2%; P = .003) compared with those in the angulated group. After adjusting for age, gender, neck diameter, and infrarenal angle (β), severe suprarenal neck angulation was associated with higher odds of type IA endoleak (adjusted hazard ratio [aHR], 8.8; 95% confidence interval [CI], 2.9-26.6), loss of primary clinical success (aHR, 4.4; 95% CI, 2.4-7.9), and 30-day mortality [adjusted odds ratio, 29.4; 95% CI, 5.3-162) compared with an α of 60° or less (all P < .001; Table). This is the first report to show a significant increase in operative mortality in patients undergoing EVAR with a severely angulated suprarenal neck. Patients who survive the operation are at increased risk of secondary interventions. These findings suggest that EVAR should be used with caution in patients with severe α angulation and underpin the role of close follow-up in this particular population.TableOutcomes after endovascular aneurysm (EVAR) repairOutcomesAngulated (n = 47)Nonangulated (n = 415)P valueAdjusted odds ratio (95% confidence interval)P value30-Day mortality, no. (%)6 (12.77)2 (0.48)<.00129.37 (5.32-162)<.0013-Year outcomes Freedom from type IA endoleak, %80.997.9<.0018.8 (2.9-26.64)<.001 Primary clinical success, %68.189.6<.0014.34(2.39-7.87)<.001 Freedom from migration, %92.6100<.001 Freedom from rupture, %97.299.024.27 (0.61-29.67).14 Long-term survival, %75.291.4.0031.9 (0.5-7.0).33 Open table in a new tab

Effects of ultrasonic instrumentation with different scaler-tip angulations on the shear bond strength and bond failure mode of metallic orthodontic brackets

ObjectiveTo evaluate the effects of ultrasonic instrumentation with different scaler-tip angulations on the shear bond strength (SBS) and bond failure mode of metallic orthodontic brackets.MethodsAdhesive pre-coated metallic brackets were bonded to 72 extracted human premolars embedded in autopolymerizing acrylic resin. The teeth were randomly divided into 3 groups (n = 24 each) to undergo no treatment (control group) or ultrasonic instrumentation with a scaler-tip angulation of 45° (45°-angulation group) or 0° (0°-angulation group). SBS was tested in a universal testing machine, and adhesive remnant index (ARI) scores were recorded. The Kruskal-Wallis test and Mann-Whitney U-test were used for statistical analysis.ResultsThe control group had a significantly higher mean SBS value than the treated groups, which showed no significant differences in their mean SBS values. The ARI scores were not significantly different among the groups.ConclusionsUltrasonic instrumentation around the bracket base reduces the SBS of metallic orthodontic brackets, emphasizing the need for caution during professional oral hygiene procedures in orthodontic patients. The scaler-tip angulation does not influence the SBS reduction and bond failure mode of such brackets.

Final Results of the Prospective European Trial of the Endurant Stent Graft for Endovascular Abdominal Aortic Aneurysm Repair

Objectives The Endurant Stent Graft System (Medtronic Vascular, Santa Rosa, CA) is specifically designed to treat patients with abdominal aortic aneurysm, including those with difficult anatomies. This is the 1-year report of a prospective, non-randomised, open-label trial at 10 European centres. Methods Between November 2007 and August 2008, 80 patients were enrolled for elective endovascular aneurysm repair (EVAR) with the Endurant; 71 with moderate (≤60°) and nine with high (60–75°) infrarenal aortic neck angulation. Safety and stent-graft performance were assessed throughout a 1-year follow-up period. Results The device was successfully delivered and deployed in all cases. All-cause mortality was 5% (4/80), with one possibly device-related death. Serious adverse events were comparable between the high and moderate angulation groups. There were no device migrations, stent fractures, aortic ruptures or conversions to open repair. Maximal aneurysm diameter decreased >5 mm in 42.7% of cases. A total of 28 endoleaks were observed (26 type II, two undetermined). Three secondary endovascular procedures were performed for outflow vessel stenosis, graft limb occlusion and iliac extension, resulting in a secondary patency rate of 100%. No re-interventions were required in the high angulation group. Conclusions The Endurant Stent Graft was successfully delivered and deployed in all cases and performed safely and effectively in all patients, including those with unfavourable proximal neck anatomy.

Severe Proximal Aneurysm Neck Angulation: Early Results Using the Endurant Stentgraft System

Objective Angulation of the proximal aneurysm neck has been associated with adverse outcome after EVAR. We aim to investigate the influence of angulation on early results when using the Endurant Stentgraft System. Methods A retrospective analysis of a prospective multicentre database identified 45 elective patients treated with the Endurant stentgraft with severe angulation of the proximal neck, which were compared to a control group without significant angulation. Endpoints were early technical and clinical success, deployment accuracy and differences in operative details. Results Mean age was 74 with 86.4% males. Mean infrarenal angle ( β) was 80.8°±16 and mean suprarenal angle ( α) was 51.4°±21. Patients in the angulated group had larger aneurysms (mean 309 cc vs. 187 cc), shorter necks (mean 27 mm ± 14 vs. 32.6 mm ± 13) and 74% (vs. 56%) were ASA III/IV. Technical success was 100%, with one patient requiring an unplanned proximal extension. No differences were found regarding early type-I endoleaks (0% vs. 0%), major postoperative complications (6.7% vs. 6.2%; p = 0.77) or early survival (97.8% vs. 96.9%, p = 0.79). Distance from lowest renal artery to prosthesis was 2.4 mm ± 2.7 vs. 2.3 mm ± 4.8, p = 0.9. Operative details were equivalent for both groups. Conclusions Treatment with the Endurant stentgraft is technically feasible and safe, with satisfactory results in angulated and non-angulated anatomies alike. No sealing length was lost in extremely angulated cases, confirming the device’s high conformability. Mid- and long-term data are awaited to verify durability, but early results are promising and challenge current opinion concerning neck angulation.

Effect of impression coping and implant angulation on the accuracy of implant impressions: anin vitrostudy

PURPOSEThe purpose of this study was to compare the accuracy of the implant master cast according to the type (pick-up, transfer) and the length (long, short) of the impression copings.MATERIALS AND METHODSThe metal master cast was fabricated with three internal connection type implant analogs (Osstem GS III analog), embedded parallel and with 10° of mesial angulation to the center analog. Four types of impression coping were prepared with different combinations of types (transfer, pick-up) and lengths (long, short) of the coping. The impressions were made using vinyl polysiloxane (one step, heavy + light body) with an individual tray, and 10 impressions were made for each group. Eventually, 40 experimental casts were produced. Then, the difference in the distance between the master cast and the experimental cast were measured, and the error rate was determined. The analysis of variance was performed using the SPSS (v 12.0) program (α = .05), and the statistical significance was set at P < .05.RESULTSThe ANOVA showed that the pick-up type impression coping exhibited a significantly lower error rate than the transfer type. However, no significant difference was observed with respect to the length of the impression coping. Additionally, no significant difference was observed between the parallel and mesial angulated groups.CONCLUSIONWithin the limitations of this study, the pick-up type impression coping exhibited a more accurate implant master cast than the transfer type in parallel group. The accuracy of the implant master cast did not differ for different lengths of impression coping of at least 11 mm. Additionally, the accuracy of the implant cast was not different for the parallel and 10° mesial angulated groups.

Asymmetry and structural system analysis of the proximal femur meta-epiphysis: osteoarticular anatomical pathology

BackgroundThe human femur is commonly considered as a subsystem of the locomotor apparatus with four conspicuous levels of organization. This phenomenon is the result of the evolution of the locomotor apparatus, which encompasses both constitutional and individual variability. The work therein reported, therefore, underlies the significance of observing anatomical system analysis of the proximal femur meta-epiphysis in normal conditions, according to the anatomic positioning with respect to the right or left side of the body, and the presence of system asymmetry in the meta-epiphysis structure, thus indicating structural and functional asymmetry.MethodsA total of 160 femur bones of both sexes were compiled and a morphological study of 15 linear and angulated parameters of proximal femur epiphysis was produced, thus defining the linear/angulated size of tubular bones. The parameters were divided into linear and angulated groups, while maintaining the motion of the hip joint and transmission of stress to the unwanted parts of the limb. Furthermore, the straight and vertical diameters of the femoral head and the length of the femoral neck were also studied. The angle between the neck and diaphysis, the neck antiversion and angle of rotation of the femoral neck were subsequently measured. Finally, the condylo-diaphyseal angle with respect to the axis of extremity was determined. To visualize the force of intersystem ties, we have used the method of correlation galaxy construction.ResultsThe absolute numeral values of each linear parameter were transformed to relative values. The values of superfluity coefficient for each parameter in the right and left femoral bone groups were estimated and Pearson's correlation coefficient has been calculated (> 0.60). Retrospectively, the observed results have confirmed the presence of functional asymmetry in the proximal femur meta-epiphysis. On the basis of compliance or insignificant difference in the confidence interval of the linear parameters, we have revealed, therefore, a discrepancy in values between the neck and the diaphysis angle and the angle of femoral neck rotation (range displacement of confident interval to a greater degree to the right).ConclusionThis study assessed the observations of a systemic anatomical study encompassing the proximal femur meta-epiphysis behavior in normal condition. This work has significance in medical practice as the theoretical basis is also required in knowing the decreased frequency and degree of severity of osteoarthritic pathologies in the dominant lower extremity.

Differential Bone Turnover in an Angulated Fracture Model in the Rat

We have developed a simple rat model of angulated tibial fracture which elicits substantial differences in bone formation and resorption within the same bone. In 35 rats the right mid-tibia was manually fractured and fixed with an intramedullary 17-gauge cannula needle. Twenty tibias were fixed in anterior angulation (27 +/- 5 degrees) and 15 in posterior angulation (31 +/- 5 degrees). Serial X-rays were taken over a 12-week period. All fractures healed completely within five weeks. In both groups, bone thickness was already significantly greater on the concave side than on the convex side at week 3 and remained so until the end of the experiment. The thickness on the convex side decreased dramatically within 3 to 5 weeks and gradually thereafter. For morphological analysis of bone mineralization, 3 rats from each group were given calcein and alizarin red injected at different time points up to 14 weeks. Maximum new bone formation was noted within the first 3 weeks. Over the ensuing weeks, new bone formation remained intense on the concave side, but it was virtually absent on the convex side. These results show that angulated fracture deformity reproducibly exhibits differential bone turnover, which can be exploited in research on local regulatory factors. To exemplify the utility of the model, an immunohistochemical study on two local markers was done. Callus tissue of five rats in the anterior angulation group at week 3 post-fracture was stained for the cytokine IL- 1beta, a stimulator of bone resorption, and the neuropeptide CGRP, an inhibitor of resorption, showing clear differences in positive staining between the concave and convex sides. Our in-vivo model offers a means of analyzing morphologically and quantitatively the differential expression and action of factors involved in local bone turnover.

Altering the angulation of a curved osteotome — Does it have effects on the type of pterygomaxillary disjunction in Le Fort I osteotomy? An experimental study

A standard Le Fort I osteotomy was performed on 12 cadavers to determine whether the incidence of pterygoid plate fractures could be reduced by increasing the angle of the curved osteotome relative to the sagittal plane. In the group where an osteotome with the usual angulation was employed, fractures occurred on 9 of 12 sides. In the increased angulation group, 5 of 12 pterygoid plates were fractured. All fractures were restricted to the level of the horizontal osteotomy cut. It is concluded that increased angulation of a curved osteotome can decrease the incidence of fractures of the pterygoid plates. This procedure, however, is not recommended because it can cause fracture of the palatine bone or displacement of the fractured pterygoid plate fragment posteriorly.